How cloud computing software helps to reduce suicide risks

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A web-based decision support system is helping practitioners manage risks associated with mental health problems, including suicide.

Mental health issues such as anxiety and depression are estimated to affect approximately one in six people at any time in the UK with an estimated cost to the economy of £118 billion annually.

Galatean Risk and Safety Technology (GRiST), partially funded by the Economic and Social Research Council (ESRC), is a mental health clinical decision support system (DSS). It was conceived and developed as a cloud computing service by Dr Fif Buckingham, Reader in Computer Science at Aston University.

GRiST (now commercialised as Egrist Ltd) has been used around the clock. Users include NHS, charity and private hospital practitioners, social care staff and people in frontline services not linked to, or containing, mental health expertise on site to assess and manage risks associated with mental health problems. These include:

  • suicide
  • self-harm
  • harm to others
  • self-neglect
  • vulnerability

Understanding the challenges

In 2021, there were 5,583 suicides registered in England and Wales, equivalent to a rate of 10.7 deaths per 100,000 people, making it the second-highest cause of death in people aged 15 to 29.

Globally, the World Health Organization predicts that by 2030, mental health problems, particularly depression, will be the leading cause of mortality and morbidity.

The challenge for mental health practitioners is that assessing those at risk of suicide requires specialist training. Previous risk-assessment tools collected unstructured data that computers found problematic to analyse and share.

For Dr Buckingham, the question was how he could develop software that accurately reflected how mental health practitioners naturally think and reason about risk so that they could make vital, often life-saving decisions.

Dr Fif Buckingham, CEO and Director of Egrist. Credit: Ann Adams

Dr Fif Buckingham, Chief Executive Officer and Director of Egrist, said:

The aim of risk assessments is not to predict the probability of a risk event, such as a suicide attempt, occurring.

Instead, it is to evaluate the level of risk, understand what has raised it, and what needs to be done to reduce the risk.

Developing the digital model

Egrist software models the judgement of psychiatrists, psychologists and mental health nurses. It uses a database of 1.5 million clinician-based risk judgements, digitally capturing health practitioners’ knowledge and reasoning processes to help trained and non-trained mental health workers determine the risk levels associated with assessments.

The result is that non-mental health-trained staff can quickly complete an Egrist risk assessment, with repeat assessments carried out efficiently, flexibly and accurately.

Using the wisdom of the crowd theory

An essential part of GRiST’s functionality is improving risk evaluation accuracy using the ‘wisdom of the crowd’ theory. In this theory the crowd consists of all the assessments and attached risk judgements from trained mental health professionals.

Over 17 years, Dr Buckingham and his team, including Dr Ann Adams of the University of Warwick, worked to understand how to adapt this ‘wisdom of the crowd’ theory into computer software, using real-life practitioner assessments to create reliable patient risk evaluations.

The two research strands were integrated to build a formal model of risk assessment expertise. They then put the research at the centre of a mental-health web-based DSS, and GRiST (now Egrist) was born, communicating data and risk levels and giving appropriate advice.

Easy to use

The researchers made GRiST straightforward, requiring no specialist software or mental health training to get started. This means practitioners in or outside mental health settings can use it easily and effectively.

Dr Buckingham said:

Egrist is easy to use because it reflects how mental health practitioners naturally think and reason about risk.

Using a scale of zero to ten for recording risk judgements, Egrist can be used by someone not trained in mental health to predict the suicide risk judgement a clinician would make within plus or minus one, with an accuracy of 80%.

Lasting impact

Thousands of non-mental health-trained workers, including social care professionals, across the UK can now safely carry out mental health risk assessments without extensive training.

To date (May 2023), Egrist:

  • has completed 2.5 million individual risk judgements in 550,000 assessments for 240,000 patients
  • has been used by 3,500 mental health practitioners in the UK
  • is accessed 24-hours-a-day, seven-days-a-week

While it’s not possible to equate this to the number of suicides prevented, Dr Buckingham says:

We know from our own data that accurate assessments reduce the likelihood of a repeat suicide attempt.

Supporting future impact

In addition, Egrist has the potential to support future impacts. For example, it:

  • has accumulated a large data set of 2.5 million individual clinical risk judgements (suicide, self-harm, harm to others, self-neglect, and vulnerability)
  • is supporting large-scale research projects investigating how mental health risks can be detected and managed more effectively
  • is recognised by the Health Foundation and Horizon 2020 for its potential for shared decision-making and collaborative care
  • is one of only four identified UK specialist mental health datasets

The team has also developed MyGRiST, web-based software that helps non-metal health-trained people assess their mental health, safety and wellbeing at home in collaboration with friends, family, carers and clinicians.

This promotes access to and active involvement in their risk and safety planning.

Commercialising GRiST

In 2018, Dr Buckingham spun out GRiST into Egrist Ltd. The company charges an annual software licence fee, directly generating income.

As a result, Egrist is linked to several patient record systems, including:

Egrist Ltd has received sponsorship from various sources, including the European Institute of Innovation and Technology and, most recently, Innovate UK.

Funding and support

GRiST was part of a £254,000 grant from ESRC, with additional funding from the Office of Behavioural and Social Sciences Research, National Institutes of Health.

Egrist has also secured the support of other key sponsors, both nationally and internationally, including:

  • NHS
  • Health Foundation
  • American Foundation for Suicide Prevention
  • EU
  • Judi Meadows Memorial Fund
  • Burdett Trust for Nursing

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